Acupuncture and Copd 2

ACUPUNCTURE AND COPD

By Michael Smith, North American Correspondent, MedPage Today Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse

Japanese scientists, evaluating the needle and the damage undone, say that acupuncture can relieve an important symptom of chronic obstructive pulmonary disorder (COPD).

In a small randomized trial, patients treated with acupuncture had less shortness of breath during exercise compared with those who received a placebo treatment, according to Masao Suzuki, PhD, of Kyoto University in Kyoto, Japan, and colleagues.

As a consequence, they also improved their ability to tolerate exercise on a standard test, Suzuki and colleagues reported online in the Archives of Internal Medicine.

Because acupuncture has been shown to improve shortness of breath in cancer patients, Suzuki and colleagues hypothesized it might have the same effect in people with COPD, where dyspnea during exercise is a significant and debilitating symptom.

To explore the idea, they examined the effect of acupuncture treatment in 68 patients with COPD of various stages who were taking standard medications. They were randomly assigned to real acupuncture or a placebo treatment, in which the needles did not penetrate the skin.

Patients and investigators were blinded to the study assignment, although the acupuncturists themselves were not.

The main outcome measure was change on the 10-point Borg dyspnea scale -- where zero is hardly breathless and 10 is severely breathless -- measured after a 6-minute walk test.

Patients were treated once a week for 12 weeks, Suzuki and colleagues reported.

They found that the baseline Borg scale score after the 6-minute walk test was 5.5, on average, in the acupuncture group, compared with 4.2 in the placebo group.

The average Borg score after 12 weeks of treatment fell to 1.9 in the acupuncture group but was slightly worse in the placebo group at 4.6.

The 3.58-point difference, in favor of acupuncture, was significant by analysis of covariance.

The improvement was also reflected in the distance patients were able to walk in 6 minutes, the researchers reported.

At baseline, the average distance walked was 405.2 meters for patients in the acupuncture group, and was 373.2 meters in the placebo group. After 12 weeks, those in the acupuncture group had gained 19.4 meters on average, while those in the placebo group had lost 63.5 meters.

The improvements are "clinically relevant," the researchers argued.

Suzuki and colleagues cautioned that all patients were on standard medications and, although there was no significant difference between groups, it is possible that there was some synergistic effect between drugs and acupuncture.

As well, it is possible that the attitude of the acupuncturists might have given patients and investigators some clues about study assignments, they noted. In addition, the study was relatively short and did not have follow-up evaluation.

The study is "thoughtful and methodologically rigorous" and "addresses an important and relevant area of research," commented George Lewith, MD, and Mike Thomas, PhD, both of the University of Southampton in Southampton, U.K.

The findings themselves need replication in larger studies, they argued in an accompanying comment article, but they also raise a host of questions about how to test the "number of mechanisms through which acupuncture may be exerting its clinical effectiveness" in clinical trials.

Among them, they said, are how to design appropriate placebo and control interventions, deciding what is a reasonable dose, what is best practice in acupuncture, and how much it costs.

The study was supported by the Japan Society of Acupuncture and Moxibustion.

The journal said the authors did not make any financial disclosures.

The comment authors did not make any financial disclosures.

Action Points

This was a randomized study in patients with COPD receiving standard medication comparing traditional acupuncture to placebo needling, both at the same acupoints once a week for 12 weeks.

Point out that this relatively small study suggests that real acupuncture reduced dyspnea on exertion and improved exercise performance.